Center for Applied Health Research on Aging (CAHRA), Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
J Gen Intern Med. 2021 Apr;36(4):916-922. doi: 10.1007/s11606-020-06423-8. Epub 2021 Feb 9.
Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual's ability to manage one's health.
We sought to examine health literacy over time among older adults using three widely used measures.
A prospective cohort study.
Community-dwelling adults ages 55 to 74 at baseline with at least one follow-up visit (N = 656) recruited from one academic internal medicine clinic and six community health centers in Chicago, IL.
Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy in Medicine (REALM) at baseline and up to three follow-up time points.
In unadjusted analyses, significant changes since baseline were found beginning at the second follow-up (mean (M) = 6.0 years, SD = 0.6) for the TOFHLA (M = - 0.9, SD = 0.95, p = 0.049) and the REALM (M = 0.3, SD = 2.5, p = 0.004) and at the last follow-up (M = 8.6 years, SD = 0.5) for the NVS (M = - 0.2, SD = 1.4, p = 0.02). There were non-linear effects of baseline age on TOFHLA and NVS scores over time (piecewise cubic spline p = 0.01 and p < 0.001, respectively) and no effect on REALM scores (B = 0.02, 95% CI - 0.01 to 0.04, p = 0.17) using multivariable mixed-effects linear regression models, controlling for race, education, income, and comorbidity.
We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.
健康素养在纵向研究中通常被视为一种静态特征，这可能会高估或低估个体管理自身健康的能力。
我们旨在使用三种广泛使用的测量方法来研究老年人的健康素养随时间的变化。
前瞻性队列研究。
从伊利诺伊州芝加哥的一家学术内科诊所和六家社区健康中心招募了年龄在 55 岁至 74 岁之间、至少有一次随访的社区居民成年人（n=656）。
使用成人功能性健康素养测试（TOFHLA）、最新生命体征（NVS）和成人医学快速估计识字能力（REALM）在基线和最多三个随访时间点测量健康素养。
在未调整的分析中，从第二次随访（基线后 6.0 年，SD=0.6）开始，TOFHLA（M=-0.9，SD=0.95，p=0.049）和 REALM（M=0.3，SD=2.5，p=0.004）出现显著变化，在最后一次随访（基线后 8.6 年，SD=0.5），NVS（M=-0.2，SD=1.4，p=0.02）也出现显著变化。TOFHLA 和 NVS 评分随时间的基线年龄呈非线性效应（分段三次样条 p=0.01 和 p<0.001），而 REALM 评分无效应（B=0.02，95%CI-0.01 至 0.04，p=0.17），采用多变量混合效应线性回归模型，控制种族、教育、收入和合并症。
我们发现，使用 TOFHLA 和 NVS 测量，随着时间的推移，年龄与健康素养呈负相关。随着自我保健需求的增加，健康素养障碍似乎在生命后期更为普遍。临床医生可能会考虑评估和应对有限的健康素养的策略，尤其是对于 70 岁及以上的患者。REALM 在 10 年的随访中表现稳定。这就提出了健康素养工具是否衡量相同属性的问题。前瞻性健康素养研究应根据其目标仔细考虑使用哪些措施。
